Carbonear doctor hopes hospital can do better

Dr. Ashraf Jarbo has worked as an internal medicine specialist in Carbonear since 2013. - Andrew Robinson

Frustrations with administration influence decision to shut down private practice

CARBONEAR, NL — A local physician shutting down his private practice hopes the situation improves at Carbonear General Hospital.

Dr. Ashraf “Ash” Jarbo is originally from Palestine and worked in Dubai as a family physician for several years before he came to Newfoundland and Labrador in 2008 for a Memorial University residency in internal medicine. He moved to Carbonear in 2013 and now has a family there with his wife, Dr. Wijdan Fadholi, who works at TC Medical Center. Both started out at the hospital in Carbonear.

“I started my whole career life, marital life and family life in this province,” he said.

Dr. Jarbo wanted to find a place where he would love to work and live. Having been in Dubai for so long, he was less interested city life and instead wanted to settle down in a small community.

“It’s different from working in a big city for multiple reasons. On a social level, you have a less stressful life. It’s a quiet place. You feel secure about your kids — especially when you have three daughters. There’s more safety and you’re more comfortable, more relaxed.”

In October of 2016 he chose to resign from the hospital and open a private practice in Carbonear. His wife had also left the hospital a few months earlier.

“It’s not comparable really between working in your private practice and working in a hospital. The hospital is, generally speaking, stressful in some ways to work in, especially when there is no good collaboration between everybody there.”

Setting up a private practice allowed Dr. Jarbo to avoid situations such as those in the hospital where he felt pressured to do things he wasn’t comfortable with.

“You work within your limits, and that’s the safety, I think. Safety for the patient, number one, and safety for me to work within my limits and not take on extra work because of the continuous operational limitations of the hospital, as they are always short in staff.”

The doctor reckons it was about three months into his stint at the hospital when he sent his first email to administration outlining his concerns about what he considered to be a stressful work environment with the potential to impact patient care. Dr. Jarbo eventually shared these concerns with the Newfoundland and Labrador Medical Association and others around the hospital.

“Now (hospital administration) think I’m the only one complaining, but … we all complain in the same department.”

While training at the Health Sciences Centre in St. John’s, he did not encounter issues similar to those in Carbonear, nor did he when handling some shifts as a temporary fill-in physician at the hospital in Clarenville.

“They have only one internist (in Clarenville) who is happy with their job. It’s (a busy) job, but he’s been there for maybe 20 years if I’m not wrong, and he’s still happy with that because there’s a friendly administration making his life easy and not giving him a hard time.”

Once he set up his private practice, Dr. Jarbo still found himself in situations where he could not come to an arrangement with the hospital to get necessary services, such as stress tests, completed. He eventually had to agree to serve as a fill-in physician for three 24-hour calls per month at the hospital in exchange for a half-day of access per week for administering stress tests.

“I said, ‘Fair enough. I will do the calls, just for the sake of helping my patient,’ because initially I used to get a lot of patients who needed stress tests, and I did not know where to go to with them. I had to refer them to another colleague to do a stress test. Their waiting list is too long. It can take up months to be done. Or, I have to send a patient to St. John’s to get a stress test done. Especially in the winter time, it’s really hard for the patient to travel from here to St. John’s just to have that test done.”

Dr. Jarbo ultimately feels negative word of mouth is hurting Carbonear when it comes to attracting general practitioners for the hospital.

He’s also aware of the struggle to attract family physicians to the area and hopes Eastern Health’s future efforts to do so prove fruitful. However, he believes one sure-fire step to aid the situation would be to loosen restrictions on foreign doctors required to work only within the hospital and instead let them handle clinics. If a family physician is known to be close to retirement, they could even be placed with that physician to become familiar with their practice and be mentored, leaving someone prepared to take their place in the process.

“Some other guys like this should be trained to cover clinics in the community to help these retiring physicians. Like TC Medical, they almost have 7,000 patients. There used to be five or six family physicians. They’re retired now. They’re left with two. Two will not be able to see all (these patients). They are unable to recruit anybody so far. They need help. They aren’t going to wait five years for a new graduate to come.”

As for the hospital administration in Carbonear, Dr. Jarbo would encourage setting up a system where those positions are filled through an election within the hospital.

The decision to leave was difficult for the doctor, who was happy to treat the patients coming through his doors — he had 5,000 total visits in one year alone and knows this has helped wait times at the hospital for internal medicine services. However, he worried about the long-term implications of having inadequate support from the hospital to meet patients’ needs.

“Honestly, I’m so pleased that I was doing everything for the best interest of the patient, and most of them were grateful for that,” he said. “But again, you need a friendly, supportive hospital. I cannot keep calling St. John’s for everything. “The patient cannot go to St. John’s to do everything. We need local support from this hospital.”